HCPCS C7542 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Outpatient PPS • Miscellaneous Surgical Procedures |
| Complexity Level | Moderate |
National average reimbursement for HCPCS C7542 by major payers:
$430.50
$N/A
$8,124.78
$N/A
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS C7542 | ||||||
United | C7542 | $2911.00 | 1285663856 - ROCKDALE MEDICAL CENTER INC., ROCKDALE HOSPITAL | 300999841 - (GA) PIEDMONT ROCKDALE HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | C7542 | $983.00 | 1437419660 - ADVANCED SURGERY CENTER OF METAIRIE LLC | 453386956 - (LA) ADVANCED SURGERY CENTER OF METAIRIE | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7542 | $3100.00 | 1790376564 - VIDALIA HEALTH SERVICES, LLC | 852556972 | GA | General Acute Care Hospital (282N00000X) |
United | C7542 | $434.00 | 1821250176 - NORTHSHORE AMBULATORY SURGERY CENTER LLC | 800352092 - (LA) NORTHSHORE AMBULATORY SURGERY CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7542 | $1815.00 | 1780690180 - HOSPITAL SERVICE DISTRICT NO. 1 OF IBERIA PARISH, IBERIA MEDICAL CENTER | 726014963 | LA | General Acute Care Hospital (282N00000X) |
United | C7542 | $398.00 | 1780865634 - NEW ORLEANS LA UPTOWN WEST BANK ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND TERAPEUTIC CENTER | 205904604 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7542 | $398.00 | 1134300080 - METAIRIE LA ENDOSCOPY ASC LLC, MGA GASTROINTESTINAL DIAGNOSTIC AND THERAPEUTIC CENTER-METAIRIE | 205904530 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7542 | $385.00 | 1093781601 - GI DIAGNOSTIC CENTER | 421583360 - (LA) GI DIAGNOSTIC CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7542 | $3939.00 | 1619504016 - BATON ROUGE GENERAL MEDICAL CENTER, THE GENERAL | 721025017 - (LA) BATON ROUGE GENERAL MEDICAL CENTER | LA | General Acute Care Hospital (282N00000X) |
United | C7542 | $434.00 | 1114929957 - OPHTHALMIC OUTPATIENT SURGERY CENTER PARTNERS, LLC, OUTPATIENT SURGERY CENTER FOR SIGHT | 721405960 - (LA) OPHTHALMIC OUTPATIENT SURGERY CENTER PARTNERS LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7542 | $2086.00 | 1871584722 - CHRISTUS HEALTH CENTRAL LOUISIANA, CHRISTUS COUSHATTA RURAL HEALTH CENTER | 720408984 - (LA) CHRISTUS HEALTH CENTRAL LOUISIANA | LA | Critical Access Hospital Clinic/Center (261QC0050X) |
United | C7542 | $3490.00 | 1932204427 - NMC OPERATING COMPANY LLC, THE SPINE HOSPITAL OF LOUISIANA | 270059959 - (LA) NMC OPERATING COMPANY, LLC | LA | General Acute Care Hospital (282N00000X) |
United | C7542 | $234.00 | 1801949631 - THIBODAUX SURGERY CENTER, LLC, BAYOU REGION SURGICAL CENTER | 320165642 - (LA) THIBODAUX SURGERY CENTER, LLC DBA BAYOU REGION SURGICAL CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7542 | $578.00 | 1891763157 - HOUMAS OUTPATIENT SURGERY CENTER | 721005613 - (LA) HOUMA OUTPATIENT SURGERY CENTER | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | C7542 | $1220.00 | 1851487086 - FAIRWAY MEDICAL CENTER, LLC, AVALA | 721426390 - (LA) FAIRWAY MEDICAL CENTER, LLC DBA AVALA | LA | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS C7542 vs. Other Miscellaneous Surgical Procedures Codes
The HCPCS C7542 code is part of the Outpatient PPS services used for Miscellaneous Surgical Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS C7542 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| C7541-HCPCS | Moderate | Diagnostic endoscopic retrograde cholangiopancreatography (ercp), including collection of specimen(s) by brushing or washing, when performed, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s) |
| C7542-HCPCS | Moderate | Endoscopic retrograde cholangiopancreatography (ercp) with biopsy, single or multiple, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s) |
| C7543-HCPCS | Moderate | Endoscopic retrograde cholangiopancreatography (ercp) with sphincterotomy/papillotomy, with endoscopic cannulation of papilla with direct visualization of pancreatic/common bile ducts(s) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS C7542. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the C7542 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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